Radiäre Narbe: eine unmögliche radiologische Diagnose

Zusammenfassung

Die radiäre Narbe ist eine typische Erscheinungsform der proliferierenden und sklerosierenden Mastopathie und histologisch ein keineswegs seltener Befund. Seit langem schreibt man ihrem Nachweis prognostische Bedeutung zu, weil sie als möglicher Risikofaktor, Marker oder Vorläufer des Mammakarzinoms gilt. Trotzdem wird die ­Läsion in der radiologischen Routinediagnostik kaum erwähnt und auch differenzialdiagnostisch selten genannt. Die Zurückhaltung ist verständlich, weil man erkannt hat, dass die bei der Erstbeschreibung Mitte der 1980er-Jahre definierten radiomorphologischen Kriterien der Läsion ihrer biologischen Vielfalt nicht gerecht werden. Auch die ergänzende bildgebende Diagnostik (Sonografie, MRT) hat die Trefferquote nicht entscheidend verbessert. Selbst wenn man die verschiedenen Verfahren kombiniert, bleiben in vielen Fällen Zweifel an der Diagnose bestehen. Sowohl die positive als auch die negative Vorher­sagewahrscheinlichkeit der bildgebenden Verfahren ist so gering, dass es ratsam erscheint, auf die radiologische Diagnose und Differenzialdiagnose der radiären Narbe zu verzichten.

Abstract

Radial scar is a typical feature of mammary pro­liferative disease and by no means a rare histo­logical finding. For a long time, its evidence has been regarded as relevant in prognosis, because it is considered to be a possible risk factor, marker lesion, or even precursor of breast cancer. All the same, the lesion is rarely described in routine X-ray findings as well as entered into the differential diagnosis. Caution is easy to grasp, since it is widely recognized that the morphological criteria of radial scars, as they have been defined in the middle of the eighties, do not cope with the bio­logical diversity of the lesion. Moreover, the complementary imaging methods (ultrasound, MRI) did not succeed in improving the accuracy mar­k­edly. Even if the different procedures are com­bined, there is still room for doubt about the final diagnosis in many cases. Correspondingly, both the positive and the negative predictive value of breast imaging are low. In conclusion, it is good policy to relinquish the radiological diagnosis and differential diagnosis of radial scars.

radiäre Narbe - komplexe sklerosierende Läsion - Mammografie - Ultraschall - MRT

radial scar - complex sclerosing lesion - mammography - ultrasound - MRI

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